Provider Demographics
NPI:1457866360
Name:RIVERA, HONG THANH
Entity Type:Individual
Prefix:MRS
First Name:HONG
Middle Name:THANH
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 GOLDENWEST ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2752
Mailing Address - Country:US
Mailing Address - Phone:714-373-4352
Mailing Address - Fax:714-892-6127
Practice Address - Street 1:15520 GOLDENWEST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2752
Practice Address - Country:US
Practice Address - Phone:714-373-4352
Practice Address - Fax:714-892-6127
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18OtherRPH